Short App Form - All Levels

A Community-based, Non-profit Music School that Supports Eastside Children

Student Bursary Application 2024 - 2025

*Please note submitting an application does not guarantee enrollment: Your completed application form will be kept on file and we will
contact you when enrollment of your child becomes possible.* SJMA provides core programing for students from grades 2 to 12.

Depending on interest, a January program for younger children may be offered in 2024-25
***Regular attendance to classes and recitals from Sept - June is required.***

Now Date

Child's Name*

First Name

Last Name

Child's Birthdate:*

School in September 2024 (Please include specifics, such ie: French Immersion, TREK, IB, Ebus, online/homeschool, etc)*

Grade they will go into in September 2024*

Are you going into a high school band program in grade 8?*

Yes No

Are you interested in lessons in:

Trombone French Horn Tuba Bassoon Flute Other

Please note that while areas of interest are taken into account, instruments assigned based on availability

Parent or Guardian's Name*

First Name

Last Name

Cell Phone*

(area code) xxx-xxxx

Home Phone

(area code) xxx-xxxx

Email Address*

Address*

Address Line 1

Address Line 2

City

Province

Postal Code

Does your child have any learning or behavioural challenges that we should know about to best meet their needs? How did you hear about us? Please share anything that you would like us to consider regarding your application. *

If your child needs additional support in group class settings, please explain. Our Music Therapy program is 1-on-1.

Do you have other children enrolled at Saint James Music Academy?

Yes No

This program is primarily for low-income families. Are you a low-income family?*

Yes No

Enrollment is not strictly based on income. We strive to give priority to families with the greatest need.

Are you a single parent home?*

Yes No

Housing Type?*

Rent Co-op Social Housing Own

Total household income*

Under $20,000 $20,000 - $40,000 $40,000 - $60,000 $60,000 - $80,000 $80,000 - $100,000 Over $100,000

Select your program preference:

Select your first choice of instrument family:

Space is limited in each instrument family

Select your second choice of instrument family:

Space is limited in each instrument family

Thank you for applying to Saint James Music Academy!